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�r <br />L A 8 0 R A T O R I E S <br />Client /H I?????5A/ <br />Address <br />A & L WESTERN LABORATORIES, INC. <br />1311 Woodland Ave. #1 • Modesto, California 95351 • Phone 209-529-4080 <br />CHAIN OF CUSTODY <br />C / <br />zip ) 3� <br />Phone "�'TG" - /GSA <br />CC to: <br />Signature of person authorizing work%'/C1' <br />under terms stated below' <br />'Net 30 days. All accounts past due will be subject to interest c rges of 1.5% per month. <br />'Hazardous materials are the property of the client. The client is responsible for proper disposal of hazardous wastes. Clients not <br />picking up hazardous wastes may be assessed an appropriate fee. <br />PROJECT ID �vv �! <br />No. <br />of <br />Con- <br />tars <br />ANALYSIS <br />r- 1 <br />REMARKS <br />SAMD BY: (S re): <br />sample <br />type Sample Location <br />Date Time G,ac Como. <br />Reli q fished b s' y)ature): <br />Date� <br />/Timeeiv <br />by (signature): <br />�lD to <br />Time <br />Relinquished by (signature): <br />Date <br />Time <br />Received y (signature): <br />Date <br />Time <br />Relinquished by (signature): <br />Date <br />Time <br />Received by (signature): <br />Date <br />Time <br />Relinquished by (signature): <br />Date <br />Time <br />Received by (signature): <br />Date <br />Time <br />Relinquished by (signature): <br />Date <br />Time <br />Received by (signature): <br />Date <br />Time <br />Site Time: <br />Start: Finish: Total Hours: <br />Driving Time: <br />Start: Finish: <br />Total Hours: <br />Dedicated Exclusively to Providing Quality Analytical Services <br />